Dr Mahmood Bhutta, a specialist registrar in otolaryngology at Guy's and St Thomas' Hospital in London, claims that the NHS could be exploiting developing countries who produce medical equipment.

Writing in the British Medical Journal, he said: "No systematic investigation has been undertaken into the sourcing of healthcare goods used in the developed world.

"When these have come from manufacturers in the developing world then, as is the case with other goods, the trade may be open to the exploitation of power by transnational companies, driving down prices and labour standards."

Dr Bhutta said the global trade in hand-held stainless steel surgical instruments was worth at least £352 million a year and many of these instruments were made by firms in Europe and Asia.

The two largest producers were Tuttlingen in Germany and Sialkot in Pakistan.

"To reduce overheads, most firms subcontract the initial production of instruments to workers employed in a small workshop or their own home, with finishing and quality checking of the product in house.

"Manufacturing firms in Pakistan, however, rarely have the infrastructure or marketing presence to allow direct trade with the end users in the destination countries. Most therefore sell to suppliers and retailers in the developed world with only a small profit margin."

Dr Bhutta said more could be done and that the solution lay "in purchasers insisting on fair and ethical trade when sourcing instruments".

GlaxoSmithKline has unveiled a H5N1 bird flu vaccine that it believes will give it a significant edge over competing treatments.

The UK pharmaceuticals group's vaccine has been produced using lower levels of antigen, the active ingredient in vaccines that causes the body to produce an immune response.

The company said the vaccine provoked a strong response in more than 80 per cent of the people tested, with a higher efficacy than any other H5N1 vaccine in development. By the end of the year the company will know if it will be possible to mass-produce the vaccine, estimating that the cost per dose could be £4. "These results are highly significant and mark real progress," said J P Garnier, GlaxoSmithKline's chief executive officer, although he added: "There is still a lot more work to be done”.

Dr David Nabarro, of the United Nations, said: "It is a good and exciting piece of science." But Prof Peter Dunnill, the chairman of University College London, said: "It would still only allow coverage of five per cent of the global population if the entire world's viral influenza vaccine capacity was used”.

Dr Paul Digard, a virologist at the University of Cambridge, said the two key problems that companies faced were producing enough vaccine in time to tackle an outbreak and not knowing the exact strain of a pandemic strain before it evolved.

Thousands of women with early breast cancer could get life-saving treatment with the official recommendation today that Taxotere should be given to patients after surgery.

Taxotere, a chemotherapy drug already given to women with late-stage breast cancer, will be given to certain women in the early stages of the disease, under draft guidance to be issued today by the government's drugs watchdog, the National Institute for Health and Clinical Excellence (Nice).

The guidance comes nine months after the Scottish equivalent of Nice, the Scottish Medicines Consortium, approved the use of Taxotere for Scottish women in the early stages of the disease.

David Miles, consultant oncologist at London Bridge hospital, said: "If Taxotere is routinely available in the UK it has the potential to prevent the deaths of hundreds of women with breast cancer each year.

"We welcome this landmark [ruling] from Nice, which represents an important step forward for the treatment of early stage breast cancer in the UK. Results from numerous clinical trials confirm that Taxotere-containing regimens are the foundation for effective treatment strategies at every stage of breast cancer”.

The guidance is still open to consultation, but the final version is not expected to be changed when it is published next month.

"Until now, the only way we had of treating inner rupture to the heart was the conventional open-heart surgery, with its high risk.

"Because we are now able to use this less invasive approach we hope to have better results in the future.

"We are encouraged by this outcome and we will be exploring the possibility of establishing this as a regular procedure for suitable patients”.

Dr Mike Knapton, director of prevention and care at the British Heart Foundation, said: "This is a welcome advance in the surgical treatment of ventricular wall rupture, which is an uncommon but devastating complication of heart attack.

"Surgical treatment to repair the rupture is required and this new procedure reduces the trauma to the already damaged heart”.

Prof Sir Liam Donaldson, the Chief Medical Officer said yesterday that billions of pounds of NHS money is being wasted every year because of variations in treatment which give rise to thousands of unnecessary operations.

Launching his annual report for England, Prof Sir Liam Donaldson, called for an end to the "unacceptable" variations which were endemic, costly and unfair.

He said some of the variation in clinical practice was on account of the preferences and habits of doctors and hospitals rather than on the needs of the patients.

For example, he said that some hospitals around the country have continued to carry out hysterectomies to treat women with excessive menstrual bleeding even though guidelines recommend that effective drugs may be used instead.

While hysterectomy rates have fallen by as much as 64% in north and central London, they have dropped by only 15% in Northumberland, Tyne and Wear.

Sir Liam said: "In my view, this level of variation in clinical practice is not acceptable."

"If hysterectomy in England could be reduced to an appropriate level across the country we would avoid nearly 6,000 operations and save more than £15 million annually”.

Prescribing patterns, tonsillectomy rates among children and treatment of people with coronary heart disease also vary unacceptably across the country, he said.

Sir Liam also warned that public health campaign budgets for areas like smoking and obesity should not be "raided" to pay for NHS deficits.

Sir Liam has also unveiled plans to set up a committee to discuss the ethical questions surrounding pandemic flu, such as who should get priority for the vaccine and on what basis critical care beds would be allocated.

Sir Liam said: "I am setting down a challenge to commissioners of health services - to reaffirm their commitment to the principle of equity and ensure their patients receive a fair service and the care they need”.

"We know there are initiatives that work and would improve health outcomes, but are not being rolled out because of financial problems in other parts of the NHS. Ring-fenced budgets must be allocated, so that the budget is not subordinated to external pressures”.

Joe Korner of The Stroke Association welcomed Sir Liam's report.

He said: "Stroke services are patchy across the country and it is vital that these are improved to save lives and improve outcomes for the estimated 150,000 people that have a stroke in the UK each year”.

A spokeswoman for the British Heart Foundation said: "We must make sure treatments are available to people who need them. Treatment must be based on need rather than postcode, and commissioning should consistently consider socio economic status and ethnicity”.

A study by the Norwegian School of Sports Science in Oslo claim that children need to exercise for at least 90 minutes a day to avoid heart disease when they are older.

The current UK guidelines recommend an hour of exercise - but recent studies found only one in 10 children of school age achieve that limit.

The researchers looked at over 1,730 children, aged nine or 15 years, from schools in Denmark, Estonia, and Portugal.

For each child they measured a combination of risk factors for cardiovascular disease, including blood pressure, weight and cholesterol, to calculate a combined risk factor score.

Over one weekend and two week days the children were asked to wear a monitor that measured how physically active they were.

The researchers found that their risk score for cardiovascular disease decreased with increasing physical activity.

The lowest risk scores were found in the nine year olds who did 116 minutes of moderate to vigorous intensity activity and the 15 year olds who did around 88 minutes daily.

This would correspond to walking at a speed of around 4 km/h for 90 minutes.

Professor Lars Bo Anderson and his team stress that the 90 minutes of daily exercise they are recommending for children would not have to be done in one chunk; it would be spaced over the day.

Neville Rigby of the International Obesity Task Force said children were being stifled from doing exercise.

"When you drive your child to the school gate in your Chelsea tractor you are not helping your child.

"Most kids in a previous generation had to walk to school, cycle to school or catch a bus”.

Professor Chris Riddoch, head of the London Sports Institute at Middlesex University and one of the researchers who conducted the latest study, agreed, saying: "We have engineered a society that does not exercise - kids as well as adults”.

He said children needed to be allowed and encouraged to be active at every opportunity.

"Every little bit helps. If we are not successful then the next generation of adults will be less healthy than we are and we are no role model”.

He said much was being done to improve the situation but that unless things changed the NHS would crumble under the strain of treating escalating ill health.

A spokeswoman from the Department of Health said policy makers would consider the implications of the new findings "very carefully in the context of our efforts to halt the rise in obesity among children under 11 by 2010."

"It is important that we keep our recommendations under review as evidence like this comes to light," she added.

She said there were a number of schemes working to increase physical activity among young people, including issuing schoolchildren with pedometers - devices that measure how many steps someone takes.

The Government also wants all school pupils to receive two hours of PE and sport a day by 2010.

Steve Shaffelburg of the British Heart Foundation said: "For children to develop a lifelong healthy attitude to physical activity, it will take a concerted effort from many groups working together to find long-lasting solutions”.

According to research people in lower social classes are biologically older than those in higher classes.

The claim follows the discovery of accelerated ageing among working class volunteers, leaving them biologically older than those higher up the social ladder.

Genetic tests revealed that being working class could add the equivalent of seven years to a person's age, whilst marrying "below" herself added years to a woman's biological age, scientists report in the journal Aging Cell today.

Professor Tim Spector, lead researcher on the study and director of the Twin Research Unit, St Thomas' Hospital, London, said: "Not only does social class effect health and age-related disease, but seems to have an impact on the ageing process itself.

"This obviously begs the question 'Why?'

"The theory we have come up with is that it is related to the stress of being in that social status compared to someone who is not in that social status.

"The strain of being in that job, the effort-reward imbalance, self esteem and just generally the psychological stress of having lots of areas you cannot control in your life are perhaps more important than we have realised”.

He said this may have a biological impact on the body, making cells divide more quickly and reducing the telomere length.

Thomas von Zglinicki, professor of cellular gerontology at the Institute of Ageing and Health, Newcastle University, said: "We did a similar study about two years ago, but we did not find a significant correlation between telomere length and socio-economic status.

"We expected to find it, and we were quite disappointed when we didn't.

He said the correlation between telomere length and social class in this new research was on the verge of being statistically significant.

"I still think this data and ours go reasonably well together. There is probably some effect of social status on telomere length.

"However, it is astonishingly weak, given the fact that socio-economic status is a very important determinant of health and of life-span, so I would have expected a much stronger effect”.

According to the first ever official survey over 28,000 people are waiting for their initial appointment with a physiotherapist in Scotland.

The unprecedented investigation found patients can face delays of up to a year for their first treatment session.

Lewis Macdonald, Deputy Health Minister, called for health boards to examine therapy services in light of the information and drive waiting times down.

Kenryck Lloyd-Jones, policy officer in Scotland for the Chartered Society of Physiotherapy, said: "We're concerned patients might be waiting for such periods before seeing a physiotherapist. Early intervention is so often essential in restoring function. We want progress to address patient need”.

Hundreds of physiotherapy students and graduates from across the UK are expected to gather in London today to protest at the lack of NHS jobs for newly qualified staff.

Researchers from the Mayo Clinic in America claim that weight loss in women may be an early sign of impending dementia.

In a study of over 1,000 people, women who later developed dementia had a drop in weight for as long as ten years before being diagnosed with Alzheimer's or other degenerative brain conditions.

Dr David Knopman, who led the study, said: "We discovered the weight of those women who developed dementia was drifting downward many years before the onset of symptoms.

"This illustrates changes that occur before the memory loss and mental decline in dementia. We believe that the brain disease began to interfere somehow with maintenance of body weight, long before it affected memory and thinking”.

The UK authors of the study, Dr Robert Stewart and colleagues from the Institute of Psychiatry, London, said: "An important consideration arising from research in this area is the extent to which weight loss may be prevented or minimised in dementia.

Past studies have suggested that dietary interventions may prevent weight loss in patients Alzheimer's disease and may delay cognitive decline and mortality.

Rebecca Wood, chief executive of the Alzheimer's Research Trust, said: "These findings need to be taking further urgently as they may reveal how dementia develops and therefore provide routes to the new treatments we so desperately need."

She added: "The difference in men and women suggested by this latest research suggests it could be linked to post-menopausal hormone changes.

"This is interesting as low oestrogen levels in women have been shown to increase the risk of dementia”.

Dr Susanne Sorensen, of the Alzheimer's Society, said: "The observed weight loss is interesting as it could indicate the part of the brain responsible for weight loss is also one of the first to be damaged by the disease.

"Further research is now needed to identify what causes this weight loss”.

A study of more than 10,000 female students from 23 countries found that they know nothing about the lifestyle habits that can influence breast cancer risk.

Just over half of those questioned were aware that genes could play a role in influencing breast cancer risk. Awareness of genetic factors was particularly high in the UK and US.

But awareness of the potential significance of lifestyle factors was much lower.

US students were most likely to be aware of their potential influence - but even here ignorance was widespread.

The study showed that more than 15% of US students identified obesity as a risk factor, compared with under 7% of their English counterparts.

While 10% of US students pinpointed the role of alcohol, the figure in the UK was just 4%.

And 18% of US female students thought exercise had an influence on breast cancer, compared to just 3.5% of English students.

Students in both the UK and US were more likely to rate stress as a significant factor - even though evidence for its effect is much more sketchy.

The study focused on university students because they were likely to be the opinion formers of the future, said Professor Jane Wardle, director of Cancer Research UK's health behaviour unit at University College, London.

"If graduates are not aware of risks, then it is unlikely that anyone else knows."

"It is very worrying that information about being overweight, having a high alcohol intake and taking little physical exercise has simply not been effectively communicated to young women in any of the countries we surveyed.

"The results of this study suggest that students could be overestimating the impact of genetic factors and are certainly underestimating the importance of lifestyle factors.

"The danger is that women who do not have relatives with breast cancer may believe that since they have a lower genetic risk they need take no account of lifestyle risks”.

Professor John Toy, medical director of Cancer Research UK, said: "The message that lifestyle can influence breast cancer risk is a very important one to get across to all women to enable them to take some control over their future lives”.